in 72,000 Urban and Rural Male Army Recruits, Ethiopia
October 21, 2003
08.15.03; Vol. 17;
No. 12: P.1835-1840; Yigeremu Abebe; Ab Schaap; Girmatchew Mamo; Asheber
Negussie; Birke Darimo; Dawit Wolday; Eduard J. Sanders
Data on national HIV
prevalence in Ethiopia are sparse, especially in rural areas where more
than 85 percent of the population lives. To support health policy
planning, Ethiopia's Ministry of Defense decided to estimate HIV
prevalence in army recruits. The current study described HIV prevalence
in relation to socio-demographic characteristics among nearly 72,000 men
recruited in 1999 and 2000. It is the first study, according to the
authors, to report extensively on rural areas.
Of 71,626 recruits
enrolled in the study 9,713, (14 percent) were from urban areas and
enrolled in 1999, and 61,913 (86 percent) were from rural areas and
enrolled in 2000. Compared to the 1994 population census, the sample of
nearly 62,000 rural recruits was fairly representative of the general
population's marital status and geographical origin, but
over-representative of Orthodox Christians and under-representative of
people without education.
found an unexpectedly low HIV prevalence in the army recruits,
contrasting with previous HIV estimates based on sentinel surveillances
among pregnant mothers in Addis Ababa and the Amhara region and recent
models suggesting that urban HIV prevalence peaked at 19 percent in 1995
and declined to roughly 15 percent in 2000, while non-urban HIV
prevalence would plateau at under 10 percent in 2000.
This study found
that HIV prevalence in rural recruits was 3.8 percent. Prevalence was
lowest in recruits ages 18-19 and highest in the 25-29 age group.
Farmers and students had the lowest overall HIV prevalence.
In urban recruits,
overall HIV prevalence was 7.2 percent. Prevalence was lowest in the
18-19 age group, increased to 9.4 percent for the 20-24 age group, and
rose to 15.3 percent among the 25-29 age group.
In rural recruits,
risk factors for HIV included higher education levels. "The impact of
education on HIV prevalence in rural areas suggests a role for primary
and secondary schools in (rural) Ethiopian HIV programs," the authors
noted. Also, rural Orthodox Christians were more likely than Muslim
recruits to have HIV. Circumcision was not a factor, as both religions
practice it. "Orthodox church officials should be involved in exploring
their potential role in HIV prevention efforts," the researchers stated.
Age and urban
residence in the Amhara region were risk factors for urban recruits,
while education and ethnicity were not significantly associated with
The authors pointed
out that in Africa, HIV prevalence can vary widely among geographical
areas. This study found pockets of high and low HIV prevalence, and the
investigators suggested that proximity to road or trading centers and
perhaps cultural factors may account for the regional differences. The
Amhara region appeared to be most affected by the epidemic, with higher
HIV estimates among both rural and urban recruits.
"The impact of
religion, education, and region on HIV prevalence suggests avenues for
targeting HIV prevention efforts in Ethiopia," the authors concluded.
"Thus our study may be instrumental in targeting HIV control efforts in
Ethiopia. It also, for the first time, provides a geographical picture
of the country's HIV epidemic, which can aid in the design and
interpretation of future HIV studies in Ethiopia."